Kathy Malas’s research while affiliated with Centre hospitalier de l'Université de Montréal (CHUM) and other places

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Publications (15)


To What Extent Can Digital Health Technologies Comply With the Principles of Responsible Innovation? Practice- and Policy-Oriented Research Insights Regarding an Organisational and Systemic Issue
  • Article
  • Full-text available

October 2024

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32 Reads

International Journal of Health Policy and Management

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Background: Digital health technologies (DHTs) have expanded exponentially since the COVID-19 crisis and have prompted questions about their impact across all levels of health systems. Because health organisations and systems play a central role in the success or failure of the transition to more equitable and sustainable societies, the concept of Responsible Innovation in Health (RIH), focused on aligning the processes and outcomes of innovation with societal values, is gaining interest in research, policy, and practice. This study aims to explore enablers and constraints to the development, procurement and/or utilisation of responsible DHTs in health organisations. Methods: Semi-structured interviews were conducted with 29 stakeholders concerned with the development, procurement, and/or utilisation of DHTs in a large Canadian academic health centre. Data were thematically analysed through a mixed deductive-inductive process using the RIH framework. Results: Our findings highlight that the consideration of RIH principles in the development, procurement, and/or utilisation of DHTs depends mainly on organisational and systemic factors and conditions, namely: (1) the presence of an organisational culture that promotes RIH in its innovation-related practices and processes; (2) availability of material and financial resources as well as expertise in certain fields (eg, environmental sustainability); (3) the evolution of health technology assessment (HTA) practices to include other dimensions beyond effectiveness, safety, and costs; (4) the scope of the regulatory and legal frameworks that govern the approval and use of DHTs; and (5) the role of the market (eg, venture capital) in the design of federal and provincial innovation policies. Conclusion: This study provides insights on practice, policy, and political issues that health organisations may face in the development, procurement, and/or utilisation of responsible DHTs. It can help scholars, practitioners, decision-makers, and industry to create the conditions for a better integration of RIH principles into health organisations and systems.

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Figure 1 Chronology of the support and communicate with families (SCF) team's interventions and mandates.
Figure 2 Perceptions of health professionals and managers of the work performed by the support and communicate with families team to address the needs of families/relatives.
Telephone calls conducted by the support and communicate with families team with relatives and clinical team members
Clinical selection criteria used to organise a visit to an end-of-life patient by care unit type Cold care units* Warm care units † and hot care units ‡
Characteristics and number of interventions for end-of-life visits and humanitarian visits for therapeutic purposes End-of-life visits Humanitarian visits
In-depth mixed-method case study to assess how to support and communicate with the families of hospitalised patients during COVID-19: a social innovation embedded in clinical teams

October 2024

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8 Reads

BMJ Open

Objectives The purpose of this study is to describe and evaluate, in a real-life context, the support and communicate with families (SCF) team’s contribution to maintaining communication and supporting relatives when patients are at the end of their lives by mobilising the points of view of SCF team members, healthcare professionals, managers and the relatives themselves. Design An in-depth mixed-method case study (quantitative and qualitative). Individual interviews were conducted with members of the SCF team to assess the activities and areas for improvement and with co-managers of active COVID-19 units. Healthcare professionals and managers completed a questionnaire to assess the contribution made by the SCF team. Hospitalised patients’ relatives completed a questionnaire on their experience with the SCF team. Setting The study was conducted in a university teaching hospital in the province of Québec, Canada. Participants Members of the SCF team, healthcare professionals, managers and relatives of hospitalised patients. Results Between April and July 2020, 131 telephone communications with families and healthcare professionals, 43 support sessions for relatives of end-of-life patients and 35 therapeutic humanitarian visits were carried out by members of the SCF team. Team members felt that they had played an active role in humanising care. Fully 83.1% of the healthcare professionals and managers reported that the SCF team’s work had met the relatives’ needs, while 15.1% believed that the SCF team should be maintained after the pandemic. Fully 95% of the relatives appreciated receiving the telephone calls and visits, while 82% felt that the visits had positive effects on hospitalised patients. Conclusion The COVID-19 pandemic forced the introduction of a social innovation involving support for and communication with families. The intention of this innovation was to support the complexity of highly emotional situations experienced by families during the COVID-19 pandemic.


Figure 1. Overall view of the intervention indicating key time points for data collection during (A) the pretransplant period and (B) the posttransplant period. CO: connected object; GRIT-F: guichet rapide d'investigation en transplantation du foie (rapid liver transplant assessment service); HCP: health care professional; LT: liver transplant.
Validated questionnaires for patient data collection and evaluation.
Telehealth-Delivered Program and Accompanying Patients to Enhance the Clinical Condition of Patients Throughout a Liver Transplant: Protocol for a Mixed Methods Study

March 2024

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52 Reads

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1 Citation

JMIR Research Protocols

Background Liver transplantation (LT) is indicated in patients with severe acute or chronic liver failure for which no other therapy is available. With the increasing number of LTs in recent years, liver centers worldwide must manage their patients according to their clinical situation and the expected waiting time for transplantation. The LT clinic at the Centre hospitalier de l’Université de Montréal (CHUM) is developing a new health care model across the entire continuum of pre-, peri-, and posttransplant care that features patient monitoring by an interdisciplinary team, including an accompanying patient; a digital platform to host a clinical plan; a learning program; and data collection from connected objects. Objective This study aims to (1) evaluate the outcomes following the implementation of a patient platform with connected devices and an accompanying patient, (2) identify implementation barriers and facilitators, (3) describe service outcomes in terms of health outcomes and the rates and nature of contact with the accompanying patient, (4) describe patient outcomes, and (5) assess the intervention’s cost-effectiveness. Methods Six types of participants will be included in the study: (1) patients who received transplants and reached 1 year after transplantation before September 2023 (historical cohort or control group), (2) patients who will receive an LT between December 2023 and November 2024 (prospective cohort/intervention group), (3) relatives of those patients, (4) accompanying patients who have received an LT and are interested in supporting patients who will receive an LT, (5) health care professionals, and (6) decision makers. To describe the study sample and collect data to achieve all the objectives, a series of validated questionnaires, accompanying patient logbooks, transcripts of interviews and focus groups, and clinical indicators will be collected throughout the study. Results In total, 5 (steering, education, clinical-technological, nurse prescription, and accompanying patient) working committees have been established for the study. Recruitment of patients is expected to start in November 2023. All questionnaires and technological platforms have been prepared, and the clinicians, stakeholders, and accompanying patient personnel have been recruited. Conclusions The implementation of this model in the trajectory of LT recipients at the CHUM may allow for better monitoring and health of patients undergoing transplantation, ultimately reducing the average length of hospital stay and promoting better use of medical resources. In the event of positive results, this model could be transposed to all transplant units at the CHUM and across Quebec (potentially affecting 888 patients per year) but could also be applied more widely to the monitoring of patients with other chronic diseases. The lessons learned from this project will be shared with decision makers and will serve as a model for other initiatives involving accompanying patients, connected objects, or digital platforms. International Registered Report Identifier (IRRID) PRR1-10.2196/54440


Telehealth-Delivered Program and Accompanying Patients to Enhance the Clinical Condition of Patients Throughout a Liver Transplant: A Research Protocol (Preprint)

November 2023

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11 Reads

BACKGROUND Liver transplantation (LT) is indicated in patients with severe acute or chronic liver failure for which no other therapy is available. With the increased number of LTs in recent years, liver centers worldwide must manage their patients according to their clinical situation and the expected waiting time for transplants. The LT clinic at Centre Hospitalier de l’Université de Montréal (CHUM) is developing a new healthcare model across the entire continuum of pre-, per-, and post-transplant care that features patient monitoring by an interdisciplinary team including an accompanying patient (AP), a digital platform to host a clinical plan, a learning program, and data collection from connected objects (COs). OBJECTIVE (1) To evaluate the outcomes following the implementation of a patient platform with connected devices and an AP, (2) to identify implementation barriers and facilitators, (3) to describe service outcomes in terms of health outcomes and the rates and nature of contact with the AP, (4) to describe patient outcomes, and (5) to assess the intervention’s cost-effectiveness. METHODS Six types of participants will be included in the study: (a) patients who received transplants and reached one-year post-transplantation before September 2023 (historical cohort/control group); (b) patients who will receive an LT between December 2023 and November 2024 (prospective cohort/intervention group); (c) relatives of those patients; (d) APs who have received an LT and are interested in supporting patients who will receive an LT; (e) healthcare professionals; and (f) decision-makers. In order to describe the study sample and collect data to achieve all the objectives, a series of validated questionnaires, AP logbooks, transcripts of interviews and focus groups, and clinical indicators will be collected throughout the study. RESULTS Five working committees (steering, education, clinical-technological, nurse-prescriptions, and AP committees) have been established for the study. Recruitment of patients is expected to start in November 2023. All the questionnaires and technological platforms have been prepared and the clinicians, stakeholders, and AP personnel have been recruited. CONCLUSIONS The implementation of this model in the trajectory of LT recipients at CHUM may allow for better monitoring and health of transplant patients, and ultimately reduce the average length of hospital stay and promote better use of medical resources. In the event of positive results, this model could be transposed to all transplant units at CHUM and across Quebec (potentially affecting 888 patients/year), it but could also be applied more widely to the monitoring of patients with other chronic diseases. The lessons learned from this project will be shared with decision-makers and will serve as a model for other initiatives involving accompanying patients, COs or interactive platforms. CLINICALTRIAL



A Comprehensive, Valid, and Reliable Tool to Assess the Degree of Responsibility of Digital Health Solutions That Operate With or Without Artificial Intelligence: 3-Phase Mixed Methods Study

August 2023

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356 Reads

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6 Citations

Journal of Medical Internet Research

Background: Clinicians' scope of responsibilities is being steadily transformed by digital health solutions that operate with or without artificial intelligence (DAI solutions). Most tools developed to foster ethical practices lack rigor and do not concurrently capture the health, social, economic, and environmental issues that such solutions raise. Objective: To support clinical leadership in this field, we aimed to develop a comprehensive, valid, and reliable tool that measures the responsibility of DAI solutions by adapting the multidimensional and already validated Responsible Innovation in Health Tool. Methods: We conducted a 3-phase mixed methods study. Relying on a scoping review of available tools, phase 1 (concept mapping) led to a preliminary version of the Responsible DAI solutions Assessment Tool. In phase 2, an international 2-round e-Delphi expert panel rated on a 5-level scale the importance, clarity, and appropriateness of the tool's components. In phase 3, a total of 2 raters independently applied the revised tool to a sample of DAI solutions (n=25), interrater reliability was measured, and final minor changes were made to the tool. Results: The mapping process identified a comprehensive set of responsibility premises, screening criteria, and assessment attributes specific to DAI solutions. e-Delphi experts critically assessed these new components and provided comments to increase content validity (n=293), and after round 2, consensus was reached on 85% (22/26) of the items surveyed. Interrater agreement was substantial for a subcriterion and almost perfect for all other criteria and assessment attributes. Conclusions: The Responsible DAI solutions Assessment Tool offers a comprehensive, valid, and reliable means of assessing the degree of responsibility of DAI solutions in health. As regulation remains limited, this forward-looking tool has the potential to change practice toward more equitable as well as economically and environmentally sustainable digital health care.


A Comprehensive, Valid, and Reliable Tool to Assess the Degree of Responsibility of Digital Health Solutions That Operate With or Without Artificial Intelligence: 3-Phase Mixed Methods Study (Preprint)

April 2023

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19 Reads

BACKGROUND Clinicians’ scope of responsibilities is being steadily transformed by digital health solutions that operate with or without artificial intelligence (DAI solutions). Most tools developed to foster ethical practices lack rigor and do not concurrently capture the health, social, economic, and environmental issues that such solutions raise. OBJECTIVE To support clinical leadership in this field, we aimed to develop a comprehensive, valid, and reliable tool that measures the responsibility of DAI solutions by adapting the multidimensional and already validated Responsible Innovation in Health Tool. METHODS We conducted a 3-phase mixed methods study. Relying on a scoping review of available tools, phase 1 (concept mapping) led to a preliminary version of the Responsible DAI solutions Assessment Tool. In phase 2, an international 2-round e-Delphi expert panel rated on a 5-level scale the importance, clarity, and appropriateness of the tool’s components. In phase 3, a total of 2 raters independently applied the revised tool to a sample of DAI solutions (n=25), interrater reliability was measured, and final minor changes were made to the tool. RESULTS The mapping process identified a comprehensive set of responsibility premises, screening criteria, and assessment attributes specific to DAI solutions. e-Delphi experts critically assessed these new components and provided comments to increase content validity (n=293), and after round 2, consensus was reached on 85% (22/26) of the items surveyed. Interrater agreement was substantial for a subcriterion and almost perfect for all other criteria and assessment attributes. CONCLUSIONS The Responsible DAI solutions Assessment Tool offers a comprehensive, valid, and reliable means of assessing the degree of responsibility of DAI solutions in health. As regulation remains limited, this forward-looking tool has the potential to change practice toward more equitable as well as economically and environmentally sustainable digital health care.


Reconnecting health through innovation

August 2022

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26 Reads

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1 Citation

Healthcare Management Forum

Learning health systems identify appropriate data to improve their performance and population health. The pandemic has shown that a proper response depends on using data from patients' needs, scientific research, hospital capacity, digital innovations, and stakeholder knowledge. Academic health centres play a role in data collection, information synthesis, and decision making supported by digital innovations. The results obtained by an academic centre and network in Quebec have demonstrated the value of integrating these elements during the pandemic and beyond.


Patients’ perceptions of the volunteer courtesy phone calls
Volunteers’ perceptions of the courtesy phone calls they made to patients
Volunteers’ perceptions of the conditions under which the calls were made
Comments made by patients on the courtesy phone calls*
Feedback from volunteers on the limits of courtesy phone calls*
Reducing social isolation during the COVID-19 pandemic: Assessing the contribution of courtesy phone calls by volunteers

May 2022

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52 Reads

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4 Citations

Context During the COVID-19 pandemic, restrictions were imposed on visits in hospitals in the province of Quebec, Canada in an effort to reduce the risk of viral exposure by minimizing face-to-face contact in order to protect patients, visitors and staff. These measures led to social isolation for patients. In order to reduce this isolation, CHUM (the Centre hospitalier de l’Université de Montréal, a teaching hospital) shifted from in-person visits to courtesy telephone calls delivered by volunteers from CHUM’s Volunteers, Recreation and Leisure Department. Objectives To study: (1) the contribution made by these calls to reducing isolation and their limitations, (2) how the calls can be improved, and (3) whether they should be maintained, based on the views of patients and volunteers. Methodology This study examined two populations. The first one consisted of 189 adult patients hospitalized at CHUM who received a courtesy phone call from a volunteer and the second one consisted of the 25 CHUM volunteers who made these calls. Quantitative data were collected from patients and volunteers through questionnaires and a Smartsheet. The patient questionnaire evaluated isolation, the courtesy phone calls, the relationship of trust with the volunteer and sociodemographic questions. The volunteer questionnaire evaluated the appropriateness of the technology for the intervention, the support and training received, the impacts of the courtesy phone call on both the patients and the volunteers, an experience report and sociodemographic information. In addition, a focus group was held with 7 volunteers. Then the verbatim were transcribed and analyzed using QDA miner software. Results From April 27, 2020 to September 5, 2020 more than 11,800 calls were made, mainly concerning hospitalization conditions or home follow-ups (n = 83), and relationships with relatives, friends, and family (n = 79). For 73.6% of hospitalized patients, the courtesy calls from volunteers were a good response to their needs, and 72% of volunteers agreed. 64.5% of patients felt less isolated and 40% of volunteers felt useful. Conclusion Our data suggest that patients felt less isolated during their hospitalization because of the courtesy calls made by the volunteers, that smartphones could also be used for video calls and, finally, that maintaining this type of service seems as relevant after as during a pandemic to provide social interactions to people isolated for medical reasons.


Figure 1. Perceptions of the performance, quality, and safety of care. (a) Respondents' perception of sense of work provided on REACTS platform vs. TELECARE Platform; (b) Respondents' perception of work environment and performance provided on REACTS platform vs. TELECARE Platform Figure 1; (c) Respondents' perception of reducing contamination measures provided on REACTS platform vs. TELECARE Platform; (d) Respondents' perception of quality of care provided on
Dimensions and items studied through the survey.
Perceptions of participants who evaluated the role and relevance (usefulness, advantages, and limitations) of Telecare-Covid.
Healthcare Professional Perspectives on the Use of Remote Patient-Monitoring Platforms during the COVID-19 Pandemic: A Cross-Sectional Study

March 2022

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76 Reads

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14 Citations

Journal of Personalized Medicine

The COVID-19 pandemic created an urgent need to act to reduce the spread of the virus and alleviate congestion in healthcare services, protect health professionals, and help them maintain satisfactory quality and safety of care. Remote monitoring platforms (RPM) emerged as potential solutions. In this study, we evaluate, from health professionals’ perspectives, the capacity and contribution of two different digital platforms to maintain quality, safety, and patient engagement in care. A cross-sectional study was conducted using a survey in which a total of 491 health professionals participated. The results show that, in general, user perceptions of the quality and safety of care provided through the platforms were positive. The ease of access to health professionals’ services in general and shorter waiting times for patients were the two main features that were highly appreciated by most participants. However, some problems were encountered during the use of these two platforms, such as a lack of training and/or direct support for users. To improve the two platforms and maximize their use, the areas for improvement and the issues identified should be addressed as part of a collaborative process involving health professionals and patients as well as health system leaders, decision-makers, and digital platform providers.


Citations (8)


... With the steadily growing role of telehealth in healthcare service delivery, the issue of confidentiality and privacy of patient information is one of the major issues that should be resolved with the highest priority. The development and establishment of tough cybersecurity procedures can minimize the chances of telehealth services getting compromised [5]. This way, both patients and healthcare providers are sure that their integrity and confidentiality are assured. ...

Reference:

Cybersecurity Protocols for Telehealth: Developing new cybersecurity protocols to protect patient data during telehealth sessions
Telehealth-Delivered Program and Accompanying Patients to Enhance the Clinical Condition of Patients Throughout a Liver Transplant: Protocol for a Mixed Methods Study

JMIR Research Protocols

... 30 Given these challenges and concerns, an emerging literature is calling for the adoption of a different innovation paradigm to ensure a responsible, equitable, inclusive, and sustainable integration of DHTs into healthcare. 1,5,22,[31][32][33][34] Responsible Innovation in Health Because health organisations and systems play a central role in the success or failure of the transition to more equitable and sustainable societies, Responsible Innovation in Health (RIH) has gained interest in research, policy, and practice. RIH is defined as "a collaborative endeavour wherein stakeholders are committed to clarify and meet a set of ethical, economic, social and environmental principles, values and requirements when they design, finance, produce, distribute, use, and discard sociotechnical solutions to address the needs and challenges of health systems in a sustainable way. ...

A Comprehensive, Valid, and Reliable Tool to Assess the Degree of Responsibility of Digital Health Solutions That Operate With or Without Artificial Intelligence: 3-Phase Mixed Methods Study
  • Citing Article
  • August 2023

Journal of Medical Internet Research

... 30 Furthermore, the SCF team is a fairly unique intervention model in the literature, by virtue of the fact that it facilitates face-to-face visits and has an impact on an entire institution. This intervention complemented the deployment of tablets and smartphones to less seriously ill patients, 24 courtesy telephone calls made by volunteers 31 and even home monitoring using a mobile application. 32 Such initiatives have also been carried out in other countries. ...

Reducing social isolation during the COVID-19 pandemic: Assessing the contribution of courtesy phone calls by volunteers

... SE Health's RPM platform, for example, supports post-discharge care by tracking patient progress in real-time, which helps to detect and address potential complications before they necessitate readmission. This continuity of care fosters better recovery outcomes and reinforces RPM's role in maintaining patient health beyond the hospital setting (1)(2)(3)(4)(17)(18)(19)(20)(21). ...

Healthcare Professional Perspectives on the Use of Remote Patient-Monitoring Platforms during the COVID-19 Pandemic: A Cross-Sectional Study

Journal of Personalized Medicine

... 49 While responsiveness and anticipation are two fundamental principles of innovation implementation processes, 50 they have not been quickly mobilised in this project. Moreover, contrary to what evidence advocates, 51 sustainability planning was late thought by the programme's initiators and a strategy for exiting the external partner. However, TUM has drawn up a sustainability plan to anticipate the cessation of support for the project, given that the government does not have the resources to sustain the support in the context of the security crisis. ...

Responsible innovation in health and health system sustainability: Insights from health innovators’ views and practices

Health Services Management Research

... SE Health's RPM platform, for example, supports post-discharge care by tracking patient progress in real-time, which helps to detect and address potential complications before they necessitate readmission. This continuity of care fosters better recovery outcomes and reinforces RPM's role in maintaining patient health beyond the hospital setting (1)(2)(3)(4)(17)(18)(19)(20)(21). ...

Remote Patient Monitoring Program for COVID-19 Patients Following Hospital Discharge: A Cross-Sectional Study

Frontiers in Digital Health

... It prioritizes patient respect, information sharing, patient engagement, and collaboration. The COV-ID-19 pandemic accelerated the adoption of telemedicine and enhanced digital healthcare technologies, facilitating the provision of homespital services [56][57][58]. According to a 2021 report by the American digital health investment firm Rock Health, investment in digital healthcare fields such as telemedicine has doubled annually since 2019 [59]. ...

Will telemedicine survive after COVID-19?
  • Citing Article
  • August 2021

Healthcare Management Forum

... 26 During the health crisis, CHUM deployed complex measures by mobilising a culture that promotes flexibility and adaptability. 27 The results highlight the fact that the SCF team's interventions made a difference by providing an environment that was respectful of relational needs in a context of extreme vulnerability. Members of the clinical team were able to support relatives and patients during difficult and emotionally charged times. ...

A model of an agile organization designed to better manage the COVID-19 crisis

Healthcare Management Forum